Little Bo’s Birth Story: Part 1

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Well we did it! It’s taken almost 7 weeks for me to find the energy to get online and share with you our news (#sleepdeprivation), but here we are!

Little Bo was born on January 15, 2016 at 4:36pm weighing 7 pounds 6 ounces and measuring 20 inches long. This is our birth story.

THE BEGINNING

If you’ve been following my blog, you know the beginning of this story actually started almost two years ago, when I committed to getting my blood sugar to a baby-ready level and overcame my deep fear of everything a diabetic pregnancy can entail. You can read about that journey here and here.

New Readers Please Note: I have Type 1 Diabetes, which is an autoimmune disease caused when the body attacks and destroys the insulin producing cells in the pancreas; it cannot be prevented or reversed. This type of diabetes is different from the kinds of diabetes you hear about more often: Type 2 Diabetes (which is usually–but not always–caused by diet/lifestyle/age) and Gestational Diabetes (a short-term condition that only occurs during the tail-end of pregnancy). That said, my experience with pregnancy will probably be a bit different from someone who has Type 2 or Gestational Diabetes. Please keep this in mind if you are reading to learn a bit more about pregnancy with these other types of diabetes. To get a brief 411 on what Type 1 Diabetes really is, you can check out this FAQ post here!

I was lucky to have a pretty “easy” pregnancy as far as pregnancy itself goes. With the exception of a little morning sickness, a cold and a bout of the stomach flu at 27 weeks, I didn’t really have any of the other pregnancy aches and pains.

What I did have, however, was a second full-time job: managing my blood sugar. Every day I watched everything I ate, counted every gram of carbohydrate and made a study of my blood sugar trends so I could keep my blood sugar where someone without diabetes would have it. There were no breaks or days off or “cheat” meals for nine months! It was truly exhausting! But I did it (and let me add I’m shamelessly proud of myself).

GEARING UP

Pre-existing diabetes is funny in pregnancy. Often one of the first signs you’re pregnant is your blood sugar can skyrocket seemingly out of nowhere. The next thing many women will find is around weeks 5-7, their blood sugar plummets as the body becomes suddenly insulin sensitive. When this happened to me, my insulin needs were cut in half!

16weeks
16 Weeks Pregnant

That lasted until about week 16, at which point my insulin needs slowly climbed until the end of pregnancy due to insulin resistance caused by the placenta. This phenomenon happens in non-diabetics as well, but typically a functioning pancreas simply compensates for the increased insulin need (when it doesn’t, you get gestational diabetes). By the time I was 37 weeks pregnant, I needed to take more than twice the amount of insulin I needed before pregnancy. It was insane.

A BUMP IN THE ROAD

After being positioned head down since week 22, Baby Girl decided at the eleventh hour that she wanted to be breech. When she didn’t turn head down by week 36, we scheduled a C-section for 39 weeks.

At first I found myself somewhat disappointed. I’ve never been one to care much about my birth experience. I knew from the beginning that as a high risk pregnancy, I would be having a hospital birth and would be monitored extra closely. Perhaps it was because of this knowledge I never went into pregnancy with any hopes and dreams of having any kind of magical birth experience. As long as baby came out healthy and safe, I was good. I did, however, draw up a short birth “wish list”:

  • I knew I wanted an epidural. Pain and stress in the body can make blood sugars rise, and high blood sugars leading up to delivery can cause baby’s pancreas (which for her is a normal, functioning organ) to produce more insulin to combat the high sugar environment of my body. However, once baby is out of my sugary womb, her little body would have more insulin in it than she needs, and her blood sugar would drop after birth. This sometimes (but definitely not always) results in a NICU stay if the low is severe enough to warrant it. Low blood sugars at birth are very common in babies with moms who have diabetes. However, whether or not the baby will have a low blood sugar after birth is very hard to predict, since even moms with steady, perfect blood sugar levels will have babies with low blood sugars at birth. It’s not unusual for this to happen to the babies of even non-diabetic mothers (although usually the lows are less severe). Regardless, if managing my pain with an epidural might–even just a little bit–help me better keep my sugars in check, thereby possibly reducing baby’s risk of low blood sugar, then the pros far outweighed the cons of not having a natural birth.

    [2018 UPDATE: I now feel totally different about epidurals! I went into my second birth with a LOT more confidence re: my ability to manage good glucose control in labor, and I very much didn’t want an epidural, as it is an intervention associated with higher C-section rates (source). Epidurals/large volumes of IV fluids in labor can also result in inflated infant birth weights which can result in unnecessary infant supplementation (source), increase breast edema, making it more difficult for baby to latch (source), and delay the onset of copious breast milk production (source).]

  • I wanted immediate skin-to-skin after birth. Immediate skin-to-skin is beneficial and recommended for a number of reasons, but the reason I so very much wanted this had once again to do with baby’s blood sugar. In addition to being a beautiful bonding moment, skin-to-skin keeps helps regulate baby’s breathing and body temperature, making it so that baby can expend less energy doing these things for herself. And since energy expenditure lowers blood sugar, naturally I was all about avoiding that.
     

  • I wanted to delay baby’s first bath. Often hospitals will give baby her first bath just a few hours after birth. Keeping baby out of water until later helps her better regulate her body temperature post birth, and a better regulated body temperature means–you guessed it–less chance of low blood sugar! (Plus, the waxy coating babies are born with helps protect them against infection).

  • I wanted the option of managing my own blood sugar during labor. My MFM and OB wanted me on an insulin/glucose drip, meaning nurses would be responsible for keeping my blood sugar in check by making adjustments to the sugar or insulin in my IV. I ultimately agreed to this, with the provision that I could keep my insulin pump infusion site hooked up to my body so I could manage my own diabetes as soon as possible after birth. After keeping my blood sugar at non-diabetic levels for over 9 months, I felt VERY confident I could manage my sugar during labor, and I wanted that option in the wings.

Unfortunately, a C-section made two of my four most-wanted birth wishes basically impossible. I’d get my pain meds, but there would be no immediate skin-to-skin since I’d be strapped to an operating table (although my OB said he would try to make this happen for me), and I would for sure have to relinquish control of my diabetes in the OR. Those both made me really uncomfortable.

27weeks
27 Weeks Pregnant

Since there was nothing I could do about it, I tried to see the positive side of things. With a scheduled C-section, I knew when I would be having the baby, and since this was my first child and all my lab work, ultrasounds and non-stress tests looked good, it was reasonably unlikely she would come before the scheduled date or have problems. My husband could plan his time off, and I could plan my trip to the hospital. Additionally, not being allowed to eat during labor (in the event of needing an emergency C-section) presents a unique challenge for someone with diabetes, since not eating can result in low blood sugars and lows require eating to correct. A planned C-section meant I could arrange to eat a filling meal 8 hours prior to check-in at the hospital, adjust my insulin accordingly to avoid a low, and keep my blood sugar in range and as steady as possible leading up to birth. After mulling it over, I started to get comfortable, thinking at least with a C-section I knew how this whole baby-having thing would go down.

A CHANGE OF PLANS

On January 10th, 17 days before my scheduled delivery, things started to look wonky. I had realized earlier that day I needed to snack a bit more throughout the day to keep my blood sugar levels up. At first I wrote it off as an “off” day. Those happen when you’re diabetic and pregnant–hormones do weird things to your sugar levels some days even if you’re doing everything else right. But that night, when I ate a meal that was a bit more carb-heavy than usual and didn’t see as steep a rise in blood sugar as I was expecting, a little red flag went up.

35weeksBG
The 24-hour CGM graph of my blood sugar levels at 35 weeks pregnant, the day after Christmas. The top line is set at 130 mg/dL and the bottom line is 75 mg/dL–these are non-diabetic glucose ranges!

Earlier that week in my Facebook support group for pregnant Type 1 moms, a member shared her birth story. She said toward the end of her pregnancy, over the course of several days she slowly found herself needing less and less insulin, and she was having low blood sugars constantly. Suddenly not needing a lot of insulin at the end of pregnancy can be alarming: If the placenta working properly means an increased need for insulin, then needing very little insulin is a sign something could be wrong with the placenta. She called her MFM (maternal fetal medicine specialist–a high risk pregnancy doctor) and reported her symptoms but was told to lie down, drink some water and do kick counts. She did this, but in her gut she knew something wasn’t right. So she headed to labor and delivery, where her OB happened to be on call. They agreed to take the baby early by emergency C-section. When the baby was born, there was almost no blood in the umbilical cord. Her OB told her that had she waited much longer to go in, her baby would have died.

With this story fresh in my mind, you can imagine my concern when on January 11th I found myself once again needing to snack to combat low blood sugars. My MFM had told me early in my pregnancy that if I experienced a reduction in insulin needs by 20% to let her know, as that is when she starts to become concerned about placental insufficiency.

I spent the next two days lowering my insulin rates on my pump as needed to avoid low blood sugars. By Tuesday the 13th, I was feeling better–my insulin needs didn’t seem to be going down as much as I thought, and I even told my OB at my routine appointment that day that I thought I would be fine. That changed when on Wednesday, I saw my blood sugar levels drop across the board. Again. I was very much nearing that 20% mark. I stayed home from work Thursday, January 14th, to try and schedule a last minute emergency appointment with my MFM the next day.

When I went to see my MFM she sat with me for about an hour, going through my blood sugar logs and CGM graphs with a fine toothed comb, looking for patterns, trying to match each rise and fall in blood sugar over the last two weeks with a particular meal or activity in order to determine what was causing these out-of-nowhere drops. We came out of the appointment having decided that I would monitor my levels closely over the weekend, and that if things got worse to let her know so they could move up my C-section date. I went home feeling cautiously optimistic: At least I had a game plan!

SURPRISE!

The next morning, Friday, January 15th, I ate breakfast and gave myself less insulin than I had given myself for the same meal the day before, hoping to avoid yet another low blood sugar. When my blood sugar ended up even lower than the previous day despite taking less insulin, I worried.

I wasn’t sure what to do. Breakfast was only one data point and this result could easily be a fluke. Was this even worth reporting? Should I continue to watch things over the weekend, or could that be waiting too long? To be safe, I figured I’d at least wait it out and see how lunch went before reporting this to my doctor. It was a Friday though, and my MFM’s office closed at 2pm. After that I wouldn’t be able to speak to her until Monday. Over the weekend, when you call the emergency line you usually end up speaking to someone who almost certainly doesn’t specialize in diabetes and pregnancy, and I didn’t want to be told to “drink water and do kick counts” by someone who doesn’t know the intricacies of my situation. So I called the office after breakfast and explained what was up. The nurse said she’d “try to reach” my MFM, who was off that day.

When I got a call back 20 minutes later, I was expecting to maybe be told that they’d moved my C-section up a week, that I’d be waltzing in Monday morning after one last weekend home during which I could clean and get things ready for the big day.

Nope!

“Dr. Gandhi and Dr. Moore agree we need to move the C-section up, so if you could come down to labor and delivery right now we can get started,” the nurse said.

Holy crap. Right now??!!

At this point I was in tears. I was scared, but it wasn’t a fear of the unknown. My hospital bag had already been packed weeks before in case of an emergency like this one, my husband and mom were on their way from work to bring me to the hospital, and I knew what goes down during a C-section, so I wasn’t too worried about that. I was, however, worried about my baby. What if she has a low blood sugar? What if she needed a NICU stay? What if the NINE ultrasounds I had during my pregnancy failed to pick up a problem? Why was my blood sugar suddenly tanking like crazy? Was that a sign something had already happened–or was in the process of happening–to my daughter?

I knew stress can make your blood sugar rise, so I took some deep breaths, took a shower using that weird soap they want you to use before surgery (my shower was cold, so that was fun), and grabbed my hospital bag.

Once my mom and husband made it back to our place to pick me up, we were off! And I was very, very nervous.

Read Part 2 of our Birth Story here!

LOVE,
GABBY